Publications (10)24.68 Total impact
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Article: Coexistence of spinal schwannoma with unusual malignant peripheral T-cell lymphoma within a lumbar spine lesion.
Acta Neurochirurgica 06/2011; 153(8):1723-4. · 1.52 Impact Factor -
Article: The place for surgical treatment for AVM involving the temporal lobe.
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ABSTRACT: The objective of this study was to analyze preoperative symptoms and late clinical outcomes in patients who underwent surgical treatment of arterio-venous malformations (AVMs) of the temporal lobe, including those involving the Sylvian fissure (SF) and the lateral wall of the inferior ventricular horns-with special respect to postoperative hemiparesis and visual field defects (VFD). Between 1990 and 2007, 44 patients (n = 22 women, n = 22 men) with a mean age of 41 (12-67) years were operated on an AVM of the temporal lobe. All data had been collected prospectively. Patients' charts, as well as surgical reports and outpatient files, were analyzed. Thirteen patients showed an involvement of the SF, and six were localized partially in the lateral wall of the temporal horn. Eight AVMs were located in the temporo-mesial region. Fourteen patients had an AVM located mainly within the visual pathway. In 24 cases, the AVM was located in the dominant hemisphere. The AVMs were classified by the Spetzler-Martin grading system (SM). Visual fields were assessed in all patients pre- and postoperatively by independent ophthalmological examiners. The initial symptoms leading to the diagnosis of the AVM were seizures in 20 cases (45%), headache without hemorrhage in six cases (14%), incidental finding in five cases (11%), and tinnitus in two cases (5%). Hemorrhage had occurred in 15 cases (34%). Based on SM, 7 AVMs were grade I, 17 grade II, 17 grade III, and 3 grade IV. Preoperatively, seven patients presented with a VFD and two with a hemiparesis. Postoperatively, 8 of 44 (18%) patients presented with a new hemiparesis, remaining permanent in 3 of 44 (7%). In two of these patients, the AVMs were localized temporo-mesially (n = 2/8, 25%). Seven patients (19%) showed a new significant postoperative VFD, and in addition, three patients had worsening of their preexisting VFD (3/7, 43%). Postoperative angiography verified complete AVM occlusion in 43 of 44 (98%) cases. One patient needed reoperation for residual AVM; hence, in all patients, complete occlusion before discharge was achieved. Treatment of temporal lobe AVMs is demanding due to their close spatio-anatomical relationship with important neurovascular structures and the optic radiation. In this surgically treated series, morbidity for a new permanent hemiparesis was 7% and preservation of the visual field could be achieved in almost 90% of all cases. This is a calculable risk for most patients that renders microsurgical resection a justifiable option, even in light of other treatment modalities. The risk for new permanent motor deficits is elevated in temporo-mesial AVMs, and these patients have to be advised accordingly for surgical treatment.Acta Neurochirurgica 02/2011; 153(2):271-8. · 1.52 Impact Factor -
Article: Surgery for spinal cord ependymomas: outcome and prognostic factors.
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ABSTRACT: Spinal cord tumors account for 5% to 10% of all primary central nervous system tumors. The most common intramedullary neoplasms are ependymomas, composing 50% to 60% of spinal neuroepithelial tumors in adults. To evaluate the clinical and oncological outcomes of patients with spinal ependymoma primarily treated with microsurgery. Patient charts and operative notes were analyzed to evaluate the clinical and oncological outcomes of 57 patients (33 men, 24 women) undergoing surgery for spinal ependymal tumors between 1987 and 2007. Mean follow-up was 67 months (range, 1-195 months; median, 56 months). Histopathological findings were 1 subependymoma World Health Organization (WHO) grade I, 16 myxopapillary ependymomas WHO grade I, 39 ependymomas WHO grade II, and 1 anaplastic ependymoma WHO grade III. Histopathological diagnoses were reviewed in 52 cases (91%) using the 2007 WHO classification. There were 47 complete resections (83%). Only 4 patients (7%) underwent (postoperative) radiotherapy. Forty-nine of 57 patients (86%) had stable or improved McCormick grades directly after surgery. A permanent decrease in the McCormick grade was seen in 4 (7%) patients. Multivariate logistic regression revealed only the preoperative neurological status of the patient as an independent predictor of functional outcome (P = .007). Recurrent tumors were diagnosed 12 to 72 months after surgery in 5 of 57 patients (9%) including 3 of 16 myxopapillary ependymomas (19%). In 4 of 5 patients, the primary tumor was incompletely resected. The progression-free survival rate was 89% and 84% for all patients at 5 and 10 years, respectively. An incomplete resection proved the only independent predictor of progression-free survival (P = .05). These results support early surgery aiming at complete resection as the primary treatment for presumed spinal ependymomas. The prognosis after surgery for some myxopapillary ependymomas seems worse than generally believed.Neurosurgery 11/2010; 68(2):302-8; discussion 309. · 2.79 Impact Factor -
Article: Surgical treatment of choroid plexus tumors.
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ABSTRACT: The purpose of this study is to evaluate the results of microsurgical treatment for choroid plexus tumors (CPT) in adult patients. From 1990 to 2008, 14 patients >18 years were treated at our institution for CPT, including seven males and seven females with a mean age of 46 years. Mean follow-up was 40 months. We reviewed the respective patients' charts, operative, and follow-up notes. Telephone interviews were performed as necessary. Neurological status was determined using the Karnofsky performance index pre- and post-operatively and at last follow-up. This series includes 12 plexus papillomas (CPP) and two atypical plexus papillomas (APP). Ten tumors were located in the fourth ventricle, two tumors in the cerebellopontine angle, one growth each in the third and lateral ventricle. In 12 cases, a complete tumor resection was achieved. No recurrence was observed in these cases. Two recurrent CPP were diagnosed 11 and 25 years after the initial surgery. Brain stem infiltration prevented a complete tumor removal in one case. In the other, the degree of resection after the first operation could not be ascertained. None of the patients received adjuvant chemo- or radiotherapy. In four patients (29%), a permanent ventricular-peritoneal shunt was necessary. Three patients initially presented with a Karnofsky index of 60 or below. During follow-up, three patients (21%) never improved beyond a Karnofsky index of 60. Surgery aiming radical excision is the key to successful treatment of CPP and APP in adults. Postoperative outcomes may be less than satisfactory in some patients.Acta Neurochirurgica 10/2010; 153(2):371-6. · 1.52 Impact Factor -
Article: View-sharing in keyhole imaging: Partially compressed central k-space acquisition in time-resolved MRA at 3.0 T.
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ABSTRACT: Time-resolved contrast-enhanced magnetic resonance (MR) angiography (CEMRA) of the intracranial vasculature has proved its clinical value for the evaluation of cerebral vascular disease in cases where both flow hemodynamics and morphology are important. The purpose of this study was to evaluate a combination of view-sharing with keyhole imaging to increase spatial and temporal resolution of time-resolved CEMRA at 3.0 T. Alternating view-sharing was combined with randomly segmented k-space ordering, keyhole imaging, partial Fourier and parallel imaging (4DkvsMRA). 4DkvsMRA was evaluated using varying compression factors (80-100) resulting in spatial resolutions ranging from (1.1×1.1×1.4) to (0.96×0.96×0.95) mm3 and temporal resolutions ranging from 586 ms/dynamic scan--288 ms/dynamic scan in three protocols in 10 healthy volunteers and seven patients (17 subjects). DSA correlation was available in four patients with cerebral arteriovenous malformations (cAVMs) and one patient with cerebral teleangiectasia. 4DkvsMRA was successfully performed in all subjects and showed clear depiction of arterial and venous phases with diagnostic image quality. At the maximum view-sharing compression factor (=100), a "flickering" artefact was observed. View-sharing in keyhole imaging allows for increased spatial and temporal resolution in time-resolved MRA.European journal of radiology 05/2010; 80(2):400-6. · 2.65 Impact Factor -
Article: Cerebral arteriovenous malformations at 3.0 T: intraindividual comparative study of 4D-MRA in combination with selective arterial spin labeling and digital subtraction angiography.
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ABSTRACT: Prospective intraindividual comparison of 4-dimensional contrast-enhanced MR angiography (4D-MRA) in combination with selective arterial spin labeling (ASL) at 3.0 Tesla and digital subtraction angiography (DSA) for anatomic and functional characterization of cerebral arteriovenous malformations (AVMs). In a prospective intraindividual comparative study, 16 patients diagnosed with symptomatic cerebral AVMs underwent 4D-MRA at an isotropic spatial resolution of 1.1 x 1.1 x 1.1 mm and a temporal resolution of 572 milliseconds, regional brain perfusion imaging using selective ASL and DSA. Selective ASL was performed for selective labeling of both carotid arteries and the vertebrobasilar complex. In a stepwise approach, all images were evaluated by 2 radiologists according to technical success rate, Spetzler-Martin classification, identification of arterial feeders, and existence of anatomic variants or functional cross-filling. 4D-MRA allowed for the same Spetzler-Martin classification as DSA in all patients. Of 28, 26 (93%) feeding arteries were correctly identified by both readers using 4D-MRA alone. Selective ASL provided additional functional or anatomic information in 4 of 16 cases (25%), enabling the detection of a cross-filling feeding artery that was not identified by 4D-MRA without selective ASL, thus improving the sensitivity of MRI in identification of arterial feeders from 26/28 (93%) to 27/28 (96%). The additional functional information regarding anatomic variants and cross-filling provided by selective ASL was confirmed by DSA in all cases. 4D-MRA in combination with selective arterial spin labeling is a promising tool for the noninvasive assessment of cerebral AVMs providing functional information that so far has been gained only with DSA.Investigative radiology 03/2010; 45(3):126-32. · 4.85 Impact Factor -
Article: Cortisol dynamics in the acute phase of aneurysmal subarachnoid hemorrhage: associations with disease severity and outcome.
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ABSTRACT: The purpose of this study was to assess cortisol dynamics in the acute phase after aneurysmal subarachnoid hemorrhage (SAH) and to set the parameters of cortisol release in relation to the severity of illness and outcome. In 22 consecutive patients with aneurysmal SAH, cortisol, corticosteroid binding globulin, interleukin-6, and adrenocorticotrophic hormone were measured immediately after hospital admission (t(0)), 7 days (t(1)) later, and at least 14 days later (t(2)). Additionally, diurnal profiles of cortisol secretion were assessed at t(1) and t(2), and area under the curve (AUC) was computed for calculated free serum cortisol (CFSC). In this study, normal diurnal CFSC profiles were associated with a significantly shorter ICU-stay, less complications, and a more favorable outcome than abnormal diurnal profiles. AUC and 8 a.m. cortisol were not related to clinical course or outcome. It is concluded that cortisol secretion patterns are associated with the severity and outcome of SAH. For an appraisal of the hypothalamo-pituitary-adrenal axis in SAH patients, single cortisol measurements are insufficient.Journal of neurotrauma 09/2009; 27(1):189-95. · 4.25 Impact Factor -
Article: Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases.
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ABSTRACT: Glomus-type spinal arteriovenous malformations (AVMs) are rare. In the literature only small series and anecdotal reports can be found, and there are no prospective series elucidating the natural course or the superiority of 1 treatment regimen over another (such as surgery versus embolization versus conservative treatment). Microsurgical treatment of spinal AVMs often seems difficult because many lesions are not anatomically suitable for primary microsurgical occlusion and are therefore treated with first-line neuroradiological interventions or not at all. Between 1989 and 2005, 20 patients with glomus-type AVMs underwent microsurgical treatment at 2 major neurosurgical centers in Germany. The history of symptoms in these patients ranged from 2 days to 11 years. Four patients presented with subarachnoid hemorrhage, 2 with intramedullary hematoma, 4 with paresthesia or pain, and 10 with clinical signs of myelopathy. Seven patients underwent partial embolization prior to microsurgery. The authors only operated on AVMs accessible from a dorsal or dorsolateral approach. Neurological status was assessed with the McCormick classification scheme. Follow-up data were obtained from outpatient records. Three patients were interviewed over the telephone and 4 patients were not available for follow-up evaluation. Surgery was performed via a laminectomy in 14 and hemilaminectomy in 6 patients. The microsurgical technique used consisted of retrograde dissection of the AVM from the venous side in most cases. Four (20%) of 20 patients showed worsening of neurological symptoms to a worse McCormick grade, probably caused by suspected venous stasis directly after surgery, however only 1 patient (5%) suffered permanent deterioration after surgery. In 14 patients postoperative angiography proved complete occlusion in 11 patients, including the presence of a remnant requiring a second operation with complete occlusion thereafter in 1 patient. In 3 patients occlusion was incomplete: a small residual AVM remained in 1 patient, and a discrete feeding vessel without a vein was evident in 2 patients. Spinal cord AVMs are rare. If embolization is not possible, surgery may be indicated in selected cases. Spinal AVMs behave differently after incomplete occlusion either surgically or with embolization. A postoperative reduction in symptoms is frequent despite the presence of small remnants, and the risk of neurological deficits seems relatively low even in residual AVMs. Therefore, treatment need not necessarily aim at complete occlusion if that would be associated with an unacceptably high risk of neurological deficits.Journal of Neurosurgery Spine 06/2009; 10(5):423-9. · 1.53 Impact Factor -
Article: Radiographic and Clinical Features in Morquio's Syndrome
Clinical Neuroradiology 11/2006; 16(4):249-253. · 1.09 Impact Factor -
Article: Association of a polymorphism of the ACVRL1 gene with sporadic arteriovenous malformations of the central nervous system.
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ABSTRACT: Important central nervous system (CNS) manifestations in patients with hereditary hemorrhagic telangiectasia (HHT) include arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). Hereditary hemorrhagic telangiectasia is caused by germline mutations of two genes: ENG (HHT Type 1) and ACVRL1 (HHT Type 2). The ENG gene variations have been associated with the formation of intracranial aneurysms. The authors studied whether sequence variations in ACVRL1 or ENG are associated with the development of clinically sporadic arteriovenous dysplasias and aneurysms of the CNS. The coding sequence (in 44 patients with AVMs and 27 with aneurysms) and the 5' end and the polyA site (in 53 patients with AVMs) of the ACVRL1 gene were analyzed for sequence variations using direct sequencing and single-strand conformational polymorphism analysis. One ENG and three ACVRL1 gene polymorphisms were genotyped using restriction enzyme-based analysis in 101 patients with sporadic AVMs and DAVFs of the CNS, 79 patients treated for intracranial aneurysms, and 202 control volunteers. The authors identified a statistically significant association between the IVS3 -35A/T polymorphism in intron 3 of the ACVRL1 gene and the development of AVMs and DAVFs (p = 0.004; odds ratio [OR] 1.73; 95% confidence interval [CI] 1.19-2.51; after adjustments for age and sex), but not aneurysms (crude OR 0.82; 95% CI 0.55-1.18). The results of this study link ACVRL1 (HHT Type 2 gene) to the formation of the clinically sporadic variants of vascular malformations of the CNS most commonly seen in patients with HHT, that is, AVMs and DAVFs.Journal of Neurosurgery 07/2006; 104(6):945-9. · 2.96 Impact Factor
Top Journals
Institutions
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2009–2011
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Rheinische Friedrich-Wilhelms-Universität Bonn
- Zentrum für Innere Medizin
Bonn, North Rhine-Westphalia, Germany
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2006
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University Hospital RWTH Aachen
Aachen, North Rhine-Westphalia, Germany
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